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My pap smear shows precancerous lesions: Should I worry?

<div><p><img src="/nairobi/PublishingImages/cervical%20cancer%20body.jpg" alt="" style="margin: 5px;"/> </p><p>Cervical cancer is the fourth leading cause of cancer death in women and yet is a very preventable disease. Cervical cancer ranks second behind breast cancer in low-income countries. According to WHO 2018, 33 in every 100,000 women in Kenya have cervical cancer and 22 per 100,000 die from the disease.</p><p>Early screening has been found to be the most effective way of detecting the disease early and managing it. At the screening level, precancerous lesions can be identified and treated to prevent them from advancing to cervical cancer. Here are answers to common questions women have regarding precancerous lesions.</p><p><strong>What are precancerous lesions?</strong></p><p>Precancerous conditions of the cervix are changes to cervical cells that make them more likely to develop into cancer. Precancerous conditions are not yet cancer, but there is a higher chance these abnormal changes will become cervical cancer if they aren&#39;t treated. </p><p><strong>Before getting cervical cancer, is it given that I will first get precancerous lesions?</strong></p><p>Precancerous lesions develop due to infection with the Human Papilloma Virus (HPV), which initially causes changes in the cells within the cervix, if left unchecked, the cells infected with the virus can cause cervical cancer up to 15 years after their infection with the virus.</p><p><strong> How can these lesions be identified early?</strong></p><p>Precancerous lesions are identified in women who undergo screening tests such as a PAP smear or HPV DNA screening tests.</p><p> <strong>What if they are detected but I leave them untreated, what can happen?</strong> </p><p>Depending on your age, if you are younger than 20 years of age, cervical lesions will regress but unfortunately in older woman or in women living with HIV precancerous lesions will progress over a prolonged period time to cervical cancer.</p><p><strong>If the precancerous lesions are detected, what treatment modalities are there for me to choose from?</strong> </p><p>The are two treatment options available including;
</p><ul><li>Cryotherapy treatment where part of the cervix is frozen with liquid nitrogen and this will destroy precancer cells on the cervix. This procedure is done in an outpatient clinic setup. The procedure takes a short time and the woman can go home after the procedure and is able to return to normal activity the day after the procedure. You will expect a watery vaginal discharge for 2 to 3 weeks. You are expected to for follow-up with your doctor in 4 to 6 months for a PAP smear test.
</div><ul><li> Large loop excision of the transformation zone (LLETZ) is a type of surgery that removes a small part of the cervix. This procedure is either done in a clinic setup or in the operating room. The most common risk is bleeding and a persistent vaginal discharge. LLETZ has been associated with a small increase in risk of having a premature birth or having a baby with a low birth weight. Rarely the cervix may become narrow after the procedure and this may cause problems with menstruation. After the procedure you will need to see a health care provider for cervical cancer screening to ensure the abnormal precancer cells are gone.</li></ul><p><strong>Are there incidences of this treatment not working and I still end up getting cervical cancer? And what could be the reason?</strong></p><p>If you undergo Cryotherapy treatment, the precancer lesion can be above the area that was frozen and this can continue to progress to cervical cancer. If you undergo a LLETZ treatment, there might be residual precancer cells deeper in the cervix thus the importance of follow up after undergoing either procedures to ensure that there are no abnormal cells. </p><p><strong>Can the precancerous lesions recur after initial treatment, what could be the reason?</strong> </p><p>A reinfection with HPV can cause a new lesion on the cervix and you will need to undergo treatment to remove the lesions again. Scheduled follow up clinics are most important aspect in the monitoring and prevention of cervical cancer.</p><p><strong><em>By Dr Khadija Warfa, Consultant Gyn-oncologist at Aga Khan University Hospital Nairobi</em></strong></p></div>

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